Introduction: Operational cardiology is an emerging field of military medicine focused on cardiovascular risk assessment and maintaining mission fitness. Military activities involve intense physical exertion, operational stress, sleep deprivation, and occupational exposures that can trigger acute cardiovascular events, including in apparently healthy individuals. The aim of this review is to synthesize data on cardiovascular risk in the military population and its implications for determining mission fitness. Materials and Methods: This review included 52 studies published between 2000 and 2026, identified in PubMed/MEDLINE, Web of Science, and Scopus. The papers were analyzed thematically: cardiovascular epidemiology, sudden cardiac death, specific risk factors, impact of exertion and operational stress, cardiovascular screening, and physiological monitoring. Results: Cardiovascular events occur predominantly during intense exertion and are frequently associated with previously undiagnosed pathology. Traditional risk factors coexist with operational stressors, increasing cardiovascular load. Cardiovascular screening and cardiorespiratory fitness assessment allow risk stratification and identification of overload. Conclusions: Integration of cardiovascular screening, fitness assessment, and physiological monitoring may reduce the risk of cardiovascular events and optimize operational safety. Standardized protocols adapted to the military environment are needed.